Pilot Debrief

BEECH A23-24 near Palo Alto, CA — 2011-08-23

Final reportWPR11FA403
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Date
2011-08-23
Location
Palo Alto, CA, USA
Airport
KPAO
Aircraft
BEECH A23-24
Registration
N5779V
Category
Airplane
Highest injury
None
Fatalities
0
Phase of flight
Climb

Probable cause

The student’s and flight instructor’s mismanagement of the fuel supply, resulting in a total loss of engine power due to fuel starvation.

NTSB narrative

After about an hour of touch-and-go landings in the pattern, the student pilot switched the fuel selector from the right to the left fuel tank. Ten minutes later, after taking off and at 300 to 400 feet above ground level, the engine sustained a total loss of power. The flight instructor performed an off-airport landing on a dirt road. During the landing roll, the airplane’s left wing struck a tree, causing the airplane to veer off the road. The previous day, flight in the airplane started with 40 gallons of fuel and it was flown for 1.5 to 2 hours. The next day, no fuel was added, and the student and instructor flew 1 hour in the pattern. The total fuel used for both flights was between 25.6 and 31.0 gallons. During the recovery of the airplane, 12 gallons of fuel were drained from the right fuel tank, and 2 cups of fuel were drained from the left. During the postaccident engine examination, fuel was supplied and the engine was successfully started and run with no mechanical malfunctions or failures that would have precluded normal operation of the fuel system or engine. Consequently, the loss of engine power was a result of fuel starvation when the student selected the empty fuel tank.

Analysis

Primary failure mode
Fuel management
First missed decision gate
Switching fuel tanks without ensuring adequate fuel in left tank.

NTSB coding

Evidence available

  • Photos
  • 9 docket documents
View NTSB final reportView NTSB docket

Docket documents9

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